Healthcare Provider Details

I. General information

NPI: 1407306012
Provider Name (Legal Business Name): PLYMOUTH PHYSICAL THERAPY SPECIALISTS LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2016
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 N LAFAYETTE ST
SOUTH LYON MI
48178-2000
US

IV. Provider business mailing address

582 N LAFAYETTE ST
SOUTH LYON MI
48178-2000
US

V. Phone/Fax

Practice location:
  • Phone: 248-573-7940
  • Fax: 248-573-7941
Mailing address:
  • Phone: 248-573-7940
  • Fax: 248-573-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BINSTEIN
Title or Position: VP/AUTHORIZED OFFICIAL
Credential:
Phone: 713-297-7000